Da Form 5840 PDF Details

The DA Form 5840 serves as a critical document for U.S. Army personnel, outlining a formal agreement where an individual accepts the responsibility of guardianship or escort in the absence of a soldier. This form, underpinned by the authority of 10 U.S.C. Section 3013, Secretary of the Army, and governed by Army Regulation 600-20, Army Command Policy, is integral for the implementation of a soldier's Family Care Plan. Its primary purpose is to ensure that, during the soldier's absence, their child or children remain under the care of a designated guardian who agrees to provide comprehensive support. This support encompasses financial, medical, educational, quarters, and subsistence needs, ensuring the well-being of the family members is maintained. Additionally, the form facilitates the guardian's access to necessary military and civilian facilities, services, benefits, and entitlements. Completion of the form is voluntary, yet crucial, as failing to provide the requested information could impede the approval of the Family Care Plan, highlighting the form's significance in maintaining the Army's operational readiness and the welfare of its members' families. A notary public's acknowledgment is required to validate the agreement, further emphasizing the legal and formal nature of this commitment.

QuestionAnswer
Form NameDa Form 5840
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform 5840 da, da form 5840 family care plan, da form 5840 fillable, da form 5840 pdf

Form Preview Example

CERTIFICATE OF ACCEPTANCE AS GUARDIAN OR ESCORT

For use of this form, see AR 600-20; the proponent agency is DCS, G-1.

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:

PRIVACY ACT STATEMENT

10 U.S.C. Section 3013, Secretary of the Army: Army Regulation 600-20, Army Command Policy.

Guardian's agreement to care for a soldier's child(ren) in his or her absence.

None.

Voluntary; However, failure to provide all the requested information could lead to rejection of a soldier's Family Care Plan.

I

 

was provided an original DA Form 5841

(Power of Attorney) or other legally sufficient authority naming me as guardian/escort for:

NAME (s) / AGE (s) OF FAMILY MEMBERS

family members of:

NAME (s)

I agree to accept responsibility for these family members. I have received all necessary documents required to provide financial, medical, educational, quarters, and subsistence support for these family members. I have been briefed on procedures for accessing military/civilian facilities, services, benefits, and entitlements on behalf of these family members.

TYPED OR PRINTED NAME OF GUARDIAN

ADDRESS (Include ZIP Code)

SIGNATURE

DATE (YYYY/MM/DD)

TELEPHONE NUMBER (Include Area Code)

E-MAIL ADDRESS

NOTARY:

STATE OF

COUNTY OF

Acknowledged before me this

 

day of

,

 

.

 

 

 

 

 

 

 

(Notary Public)

My commission expires:

DA FORM 5840, JUN 2010

PREVIOUS EDITIONS ARE OBSOLETE.

APD PE v1.00ES

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